Tuesday, March 24, 2009

NewFNP is totally cool with mental health days. Go to the Korean Day Spa for a naked lady Rub-n-Scrub and shed that nasty dead skin! Go see I Love You, Man and eat a large popcorn. Sleep. Whatever.

But do not be newFNP's MA and call in sick when you are, in fact, getting new boobs.

Sure, go ahead and get your new knockers. Whatever. Your life is hard. Your soon-to-be-ex-husband is a dick. NewFNP understand the urge to make a change when a relationship ends. But take a day and get a frigging facial, a hair-do and some airbrushed Coach nails.

But when you are having cosmetic surgery, you should take a vacation day (or seven). You should not be the employee that burdens her colleagues for boobs. And just how much is newFNP's clinic paying these MA's, for the love of God, if they are taking sick days for rack enhancement?!!

Honestly, newFNP just does not understand the desire for two inflated saline balloons in one's chest. Just get some boob cutlets and a push-up bra and call it a day. Total cost - fifty bucks. Less if you hit up the semi-annual sale at VS.

But even more of a bummer is that newFNP has really felt like this employee was committed to the team and understood the importance of her role.

And that changed today. Possibly even as much as her MA's new cup size.

Wednesday, March 11, 2009

There are times in everyone's role transition in which they wonder if they are, in fact, cut out for the career they chose.

NewFNP had several such instances in which she thought - whoa pal... perhaps law school.

The first involved a patient who had a horrendous necrotic pressure sore that was so deep, it almost exposed the bone. This woman also had MRSA which meant that all staff were on contact precautions which, in newFNP's training hospital, consisted of a mask, gloves and a plastic gown.

It was the end of the day's rotation and newFNP had been busy as hell. She hadn't eaten. She was tired. And the smell of that pressure sore plus the tenting of the skin as the physician cut away necrotic tissue plus newFNP's hunger plus the millions of people in the room causing increased temps (and smell) plus the plastic precautions gown equaled newFNP sitting on the floor with her head between her knees in an attempt not to pass out.

A successful attempt, but clearly not a shining moment in student nursing history.

Another involved a patient who had undergone a partial pneumonectomy and, for reasons that now escape newFNP's memory, had failed to heal well. As a result, he had what is best described as a gill-like slit in his side that moved in a gill-like fashion when he breathed. And in that gill-like slit, there were strings of mucous that would quiver during respiration.

The vivid recollection sends cold shivers down newFNP's spine.

NewFNP left the room and told her preceptor, "I don't think I'm cut out to be a nurse" to which her preceptor raised one eyebrow - her way of saying that she disagreed.

NewFNP wrote about another unsatisfying olfactory experience three years ago. NewFNP recalls feeling so disheartened. How on earth would she take care of her patients if she could not even observe this procedure and remain on her feet? she wondered. NewFNP's consulting physician attempted to console her by confirming that that was, in fact, a hella smelly abscess but it didn't really make newFNP feel much better.

NewFNP has come a long way, baby. In these past three and a half years, newFNP has incised and drained her fair share of abscesses, but for the past year, the abscesses had dried up.

Until today.

When newFNP hasn't performed a procedure in a while, she feels a tad apprehensive prior to embarking upon one. Especially when it involves a scalpel and lidocaine and inflicting pain. But the beauty of having a few years under one's belt is that it all comes back to you when you need it. For better or for worse, even the inflicting pain becomes easier in one of those you've got to be cruel to be kind kind of ways.

And - gross though they may be - procedures are kind of fun. They are so much better to perform than to observe. In the case of an abscess, the results are immediate. The smell doesn't seem to bother newFNP so much when she is doing the cutting, expressing, irrigating and packing.

In fact, she wonders how her MAs are such tough asses in their assisting whereas newFNP has near syncopal episodes.

NewFNP is ready for more!

Again, for those struggling students out there, it's worth it. You'll be ready, too.

Sunday, March 08, 2009

NewFNP has read article after article lamenting the primary care physician shortage. Often times, this is attributed to the high cost of medical school education. It's true - med school is expensive. It's true - physicians can make more money in specialty practice.

Nonetheless, these articles make newFNP a little pissy.

Jut hold up, mofos. There are nurse practitioners out there who are thrilled to be primary care providers. Nay, they chose to be NPs because they wanted to provide primary care. They wanted to prevent illness, they wanted to treat the whole person and not the disease. They wanted to be part of a health care team. They wanted to judiciously refer to specialty when the situation necessitated the referral.

And guess what? They have debt. They may even have a shitload of debt.

NewFNP's fancy NP school was seven semesters in length. The total tuition cost was in the neighborhood of $98,000. That's just the tuition. That's no rent, no books, no required health insurance, no specific-colored scrubs so as to identify students as students, no RN license. That's no red wine, no haircuts, no used book cafe coffee & treats with one's lady friends. And, at newFNP's school, there were a fair number of us who had other graduate degrees and their associated student loans. Thank heavens for the in-school deferment!

And thank heavens for loan repayment which mercifully wiped out quite a chunk of newFNP's debt, which now totals just a smidge over $60,000. Ah - $60,000 - it seems so reasonable.

So what is newFNP saying? She's simply saying: yo -- NPs! She feels your pain. You work hard, you take good care of your patients, you pay your six-figure student loan debt. Keep it up.

And for those of you in fancy and pricey NP schools, it's worth it. It's totally frigging worth it.

Saturday, March 07, 2009

NewFNP noted recently that the economy is really hurting her patients.

It's worse now.

NewFNP referred three adult men and one pregnant women to food banks this week. Adult men in newFNP's clinic, as a rule, are a stoic bunch. They do not tell you that they are hurting or sad or worried. This week, newFNP saw desperation and fear in her patients' eyes - worries that they will not be able to feed their families, let alone pay their rent.

NewFNP hears on the news that lines for food assistance are longer, she hears the monthly unemployment numbers. She wonders if robbery is increasing as people become more desperate. Will the incidence of domestic violence increase?

During the Great Depression, unemployment rates were around 25%. In newFNP's county, they were almost 11% in January, a 3% increase since September. In newFNP's service area, unemployment is between 12-19%, depending on the zip code.

If you live in the hood, this is a depression. It is a depression. NewFNP's 401k is going through a recession but she has food on the table and gas in the car and not one but three paying jobs.

NewFNP is acutely aware between the haves (her) and the have-nots (her patients) as she sits in the exam rooms, listens to their stories and provide them with the best care she can given that the answer to their worries lies outside of the exam room walls.

On a lighter note, the aggressive-statement-maternity T-shirt shop does not appear to be struggling at all. NewFNP's non-fronting pregnant teen showed up to clinic this week wearing a shirt telling everyone to STOP HATIN. The graphic was, of course, a faded stop sign.

This blog is for new NPs or NP students who want some real 411 on the life of a new practitioner. A new practitioner in a busy, understaffed, urban community health clinic in a major metropolitan area. Oh, and newFNP swears while writing and, sometimes, while working although she tries to keep those swears to herself. Consider yourself warned.